Intubation: Difficult Airway

This chapter focuses on the difficult airway algorithm during the intubation process. The current published recommendations will address the definition of the difficult airway, steps by which to secure the airway, and when to employ a surgical airway in the form of tracheotomy or cricothyrodotomy. Finally, the role of the Otolaryngologist-Head and Neck Surgeon will be highlighted in the difficult airway team which should be multidisciplinary when handling airway concerns in a hospital. Overall, the goals of this chapter are to educate the reader on how to critically analyze and decide on the means to adopt a difficult airway algorithm in their own institution(s)

Transoral thyroidectomy and parathyroidectomy \ue2\u80\u93 A North American series of robotic and endoscopic transoral approaches to the central neck

Objective Most thyroid surgery in North America is completed via a cervical incision, which leaves a permanent scar. Approaches without cutaneous incisions offer aesthetic advantages. This series represents the largest series of transoral vestibular approaches to the central neck in North America, and the first published reports of robotic transoral vestibular thyroidectomy for thyroid carcinoma. Materials and methods Data was prospectively collected for patients that underwent transoral vestibular approach thyroidectomy and/or parathyroidectomy between April 2016 and February 2017. Results Fifteen patients underwent the procedure for removal of the thyroid (n\uc2\ua0=\uc2\ua012), parathyroid (n\uc2\ua0=\uc2\ua02) or both thyroid and parathyroid glands (n\uc2\ua0=\uc2\ua01). The first case was converted to an open procedure. Fourteen were completed through these remote access incisions, including patients with a body mass index as high as 44. There were no permanent complications. The postoperative median Dermatology Life Quality Index score was 3, which indicates a small effect on quality of life. Conclusion The transoral vestibular approach to the central neck is a promising technique for patients who desire to optimize aesthetics

Immediate and partial neural dysfunction after thyroid and parathyroid surgery: Need for recognition, laryngeal exam, and early treatment

BackgroundLaryngeal dysfunction after thyroid and parathyroid surgery requires early recognition and a standardized approach for patients that present with voice, swallowing, and breathing issues. The Endocrine Committee of the American Head and Neck Society (AHNS) convened a panel to define the terms - immediate vocal fold paralysis- and - partial neural dysfunction- and to provide clinical consensus statements based on review of the literature, integrated with expert opinion of the group.MethodsA multidisciplinary expert panel constructed the manuscript and recommendations for laryngeal dysfunction after thyroid and parathyroid surgery. A meta- analysis was performed using the literature and published guidelines. Consensus was achieved using polling and a modified Delphi approach.ResultsTwenty- two panelists achieved consensus on five statements regarding the role of early identification and standardization of evaluation for patients with - immediate vocal fold paralysis- and - partial neural dysfunction- after thyroid and parathyroid surgery.ConclusionAfter endorsement by the AHNS Endocrine Section and Quality of Care Committee, it received final approval from the AHNS Council.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163592/2/hed26472.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163592/1/hed26472_am.pd